=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518208560
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KYLE A WEBER PHD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2013
-----------------------------------------------------
Last Update Date | 12/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 NAPERVILLE WHEATON ROAD SUITE 201
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-383-9857
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1555 NAPERVILLE WHEATON ROAD SUITE 201
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-383-9857
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LICENSED CLINICAL PSYCHOLOGIS
-----------------------------------------------------
Name | DR. KYLE ASHLEY WEBER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 630-383-9957
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071.007960
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------